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http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Bone_Regeneration_of_the_Maxillofacial_Region.57.aspx
No abstract available]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00057http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/09000/Guideline_for_Care_of_Patients_With_the_Diagnoses.3.aspx
No abstract available]]>Tue, 01 Sep 2015 00:00:00 GMT-05:0000001665-201509000-00003http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/07000/Quantitative_Analysis_of_Change_in_Intracranial.6.aspx
Abstract: Posterior cranial vault distraction is considered to be more effective for increasing intracranial volume than fronto-orbital advancement or anterior cranial vault expansion, but the changes in intracranial volumes after posterior cranial vault distraction remain unclear. The changes in intracranial volume were investigated in patients of premature craniosynostosis treated by this technique. Seven patients, 3 boys and 4 girls aged from 5 months to 3 years 3 months (mean 23 months) at operation, with craniosynostosis underwent posterior cranial vault distraction at Juntendo University Hospital from 2011 to 2014. Patient characteristics, length of distraction, and pre- and postoperative computed tomography findings were reviewed. Total intracranial volume, including the supratentorial space and posterior cranial fossa, was measured using the workstation functions on three-dimensional computed tomography scans. Posterior distraction was performed without severe complications except in 2 patients requiring additional surgeries. The distraction length was 22.3 to 39 mm (mean 31 mm), the intracranial volume change was 144 to 281 mL (mean 192 mL), and the enlargement ratio of intracranial volume was 113% to 134% (mean 121%). The present quantitative analysis of intracranial volume change after posterior distraction showed greater increases in intracranial volume compared with previous reports. Furthermore, intracranial volumes in our patients became nearly normal and were maintained for the follow-up period (maximum 13 months). Posterior cranial vault distraction is very effective to increase cranial volume, so may be the first choice of treatment in patients of craniosynostosis.]]>Fri, 01 Jul 2016 00:00:00 GMT-05:0000001665-201607000-00006http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/09000/Analysis_of_Fractured_Mandible_Over_Two_Decades.17.aspx
Abstract: Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important.
In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4–69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus–parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation.
In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary.]]>Thu, 01 Sep 2016 00:00:00 GMT-05:0000001665-201609000-00017http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Fully_Endoscope_Controlled_Clipping_Bilateral.52.aspx
Abstract: Clipping bilateral middle cerebral artery (bMCA) aneurysms via unilateral approach in a single-stage operation is considered as a challenge procedure. To our knowledge, there is no study in surgical management of patients with bMCA aneurysms by fully endoscope-controlled techniques. The author reported a patient with bMCA aneurysms who underwent aneurysms clipping via a unilateral supraorbital keyhole approach by endoscope-controlled microneurosurgery, and the patient had an uneventful postoperative course without neurologic impairment and complication. Furthermore, the author discussed the advantages and adaptation of endoscope-controlled clipping bMCA aneurysms via unilateral supraorbital keyhole approach.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00052http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/The_Clinical_Feasibility_of_Newly_Developed_Thin.44.aspx
Introduction: In recent years, bioresorbable plates have undergone remarkable development. However, there has been no attendant improvement in their strength, because strength requires thickness, and complications such as palpability are related to the thickness of bioresorbable plate systems. In this clinical study, we compared the surgical management of zygomatic fractures using newly developed thinner bioresorbable materials or conventional titanium miniplates.
Methods: Twelve patients with zygomatic fractures were randomly divided equally into 2 groups (6 with new bioresorbable osteosynthesis materials and 6 with standard titanium miniplates). Using computed tomography, we evaluated the thickness of the soft tissue and plate at the zygomaticofrontal sutures in each patient with the help of detailed radiographic computed tomography data at 6 months postoperatively. We compared the amount of soft-tissue volume increase between the uninjured healthy and injured operated sides in each patient.
Results: Both groups eventually achieved satisfactory healing, with a favorable restoration of form and function and without any complications, including palpability. The amount of soft-tissue volume increase at the operated side relative to the uninjured healthy side using new thin bioresorbable plates was 131.1% (range: 101.5–165.8). On the other hand, that of titanium miniplates was 126.4% (range: 102.2–167.6). There was no statistically significant difference (P > 0.05).
Conclusion: This newly developed thinner flat-type bioresorbable plate system could be considered clinically useful in the treatment of zygomatic fractures even in easily palpated areas, such as the infraorbital rim or zygomaticofrontal sutures, without any healing differences in skeleton as compared with conventional titanium miniplates.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00044http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/09000/Mutational_Analysis_of_TCOF1,_GSC,_and_HOXA2_in.95.aspx
Abstract: Treacher Collins syndrome is an autosomal dominant craniofacial malformation mainly caused by mutations in the TCOF1 gene. Few cases have been observed in the Chinese population. Herein, the authors report the mutational analysis of TCOF1, GSC, and HOXA2 to determine the mutational features of the 3 genes in Chinese patients with Treacher Collins syndrome. Genomic DNA of the patients and their parents was extracted from peripheral blood following a standard protocol. DNA sequencing analysis was performed on all exons and the exon-intron borders of TCOF1, GSC, and HOXA2 in addition to the 1200-bp upstream of TCOF1. Four novel single nucleotide polymorphisms were detected in TCOF1, one of which was in the promoter region. Mutations in GSC and HOXA2 were not found in the 3 patients. Our results suggest the possibility of genetic heterogeneity or different mechanisms leading to the disease. Further functional study of the alteration is necessary to obtain more definitive information.]]>Thu, 01 Sep 2016 00:00:00 GMT-05:0000001665-201609000-00095http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/06000/Postoperative_Low_Flow_Cerebrospinal_Fluid_Leak_of.67.aspx
Abstract: To assess the effectiveness of continuous lumbar drainage (LD) for management of postoperative cerebrospinal fluid leaks after endoscopic endonasal transsphenoidal approach for resection of pituitary adenoma.
Three hundred eighty-four medical records of patients who were admitted to our institute during a 2.5-year period were retrospectively reviewed, 33 of them experienced low-flow cerebrospinal fluid leak postoperatively. If LD was used, all patients with low-flow cerebrospinal fluid leak were classified into 2 groups, lumbar drained group and conservatively treated group. The age, sex, management of cerebrospinal fluid leaks, and related complications were reviewed. Statistical comparisons between the 2 groups were made using SPSS 19.0 (IBM Corp, Armonk, NY). The differences were considered statistically significant if the P value was less than 0.05.
Thirty-three of 384 (8.6%) experienced low-flow postoperative cerebrospinal fluid leaks. Cured rate of cerebrospinal fluid leak was 94.4% (17/18) in continuous lumbar drained group, and 93.3% (14/15) in control group. There were 2 (11.2%) patients who developed meningitis in the LD group and 1 (5.6%) patient in the control group. One patient required endoscopic repair of skull base because of persistent cerebrospinal fluid leak in both groups, with the rates of 5.6% and 6.7%, respectively. There was no significant difference noted in each rate in both groups.
Placement of LD may not be necessary for the management of low-flow postoperative cerebrospinal fluid leak after using endoscopic endonasal transsphenoidal approach to pituitary adenoma.]]>Mon, 01 Jun 2015 00:00:00 GMT-05:0000001665-201506000-00067http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/06000/Globalization_of_Craniofacial_Plastic_Surgery__.8.aspx
Abstract: International Humanitarian Interchanges are a bona fide component of surgery and medicine. Additionally, these programs also provide substantial benefit both to the doers and the recipients.
The foreign mission program is potentially a weapon of foreign policy which is underutilized and underestimated.
Physician job dissatisfaction is increasing. However, the happiness and satisfaction of the participants in the short-term multidisciplinary trips, repeated, well-organized and respectful, with rather complete integration of the surgical system of the sister countries (“Plan B”), approaches 100%.
The theory of the International Humanitarian Interchanges is based on substance, on medical theory. These trips are particularly successful in interchanges with medium-resourced countries.
Furthermore, the academic visiting professor (“Plan A”: hi-resource place to hi-resource place), the One Man Can Save the World model (“Plan C”: to the low-resource place), and the intriguing Horton Peace Plan have possibilities for long-term benefit to the doer, recipient, the field of surgery, and the body of knowledge. In all of these, our country and the family of nations advance.
The theoretical basis is not always religious nor the grand strategy plan; both have either proselytizing or political dominance as primary motives, and are mentioned as historically helpful.]]>Mon, 01 Jun 2015 00:00:00 GMT-05:0000001665-201506000-00008http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/03000/Graded_Porous___Tricalcium_Phosphate_Scaffolds.109.aspx
Abstract: Bone augmentation requires scaffold to promote forming of natural bone structure. Currently, most of the reported bone scaffolds are porous solids with uniform pores. The aim of the currentstudy is to evaluate the effect of a graded porous β-tricalcium phosphate scaffolds on alveolar bone augmentation. Three groups of scaffolds were fabricated by a template-casting method: (1) graded porous scaffolds with large pores in the center and small pores at theperiphery, (2) scaffolds with large uniform pores, and (3) scaffolds with small uniform pores. Bone augmentation on rabbit mandible wasinvestigated by microcomputed tomography, sequential fluorescentlabeling, and histologic examination 3 months after implantation.The result presents that all the scaffold groups maintain their augmented bone height after 3-month observation, whereas the autograftinggroup presents an obvious bone resorption. Microcomputed tomography reveals that the graded porous group has significantly greater volume of new bone (P < 0.05) and similar bone density compared with the uniform pores groups. Bone substance distributes unevenly in all the 3 experimental groups. Greater bone volume can be observed in the area closer to the bone bed. The sequential fluorescentlabeling observation reveals robust bone regeneration in the first month and faster bone growth in the graded porous scaffold group than that in the large porous scaffold group. Histologic examinationsconfirm bone structure in the aspect of distribution, activity, and maturity. We conclude that graded porous designed biodegradableβ-tricalcium phosphate scaffolds are beneficial to promote bone augmentation in the aspect of bone volume.]]>Sun, 01 Mar 2015 00:00:00 GMT-06:0000001665-201503000-00109http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Assessment_of_Surgery_Resident_Competency_Provided.40.aspx
Abstract: The objective of this study was to assess the competency of surgery residents from the patient perspective in the current healthcare environment in China. The authors performed an assessment of 508 surgery residents in Liaoning province. Seven patients were as a group to complete the self-administered questionnaires on the survey for each individual corresponding resident. A 5-point rating scale with an unable-to-evaluate category was used to assess surgery resident competency by patients. Reliability and validity were assessed by Cronbach alpha (α) and exploratory factor analysis, respectively. Statistical analysis was performed using SPSS 13.0. The surveys on 421 residents were valid, and the valid response rate was 82.8%. A total of 2947 questionnaires from patients were analyzed in this study. The Cronbach α coefficient was 0.92. The 4 factors emerging in the exploratory factor analysis reached a cumulative contribution rate of 66.98%. The items of “promotes health maintenance (talks about preventive care)” (206/7.0%), “tells me about any side effects of the medicine” (177/6.0%), “spends enough time with me” (189/6.4%), and “answers my questions thoroughly” (168/5.7%) were scored <4 by higher percentage of patients. The instrument provided an acceptable means for patients to evaluate the competency of Chinese surgery residents. Surgery residents should improve their competencies on preventive care, patient safety, and communication skills.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00040http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/03000/Risk_Factors_for_Life_Threatening_Complications_of.24.aspx
Abstract: The purpose of this study was to review the clinical features of maxillofacial space infection (MSI), and to identify the potential risk factors predisposing to life-threatening complications. A retrospective review of the medical charts of patients with MSI treated at Peking University School and Hospital of Stomatology from August 2008 to September 2013 was conducted. A total of 127 patients [75 men (59.1%) and 52 women (40.9%); mean age, 45.39 ± 21.18 years, with a range of 1–85 years] formed the study cohort. The most common cause of MSI was odontogenic infection (57.5%). The most common space involved was the submandibular space. All patients were treated by antibiotics as well as surgical incision and drainage. Sixteen patients developed life-threatening complications, and the dominant complication was respiratory obstruction. Multivariate logistic regression analysis revealed the percentage of neutrophils (NEUT%) upon hospital admission ≥85.0% to be associated with life-threatening complications (P Tue, 01 Mar 2016 00:00:00 GMT-06:0000001665-201603000-00024http://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/05000/Intraoral_Zygoma_Reduction_Using_L_shaped.8.aspx
Background: Because of the various defects of malarplasty, including a large incision, much bleeding, visible scars after the operation, and so on, caused by the conventional coronal incision or the temporal incision with the intraoral incision approach, the malarplasty by simple intraoral approach is an innovative development.
Methods: Through the intraoral approach and subperiosteal dissection, we can reach the osteotomy point on the zygomatic body directly and arrive at the osteotomy point at the zygomatic arch end along the medial side of the zygoma. A new L osteotomy is applied with the reciprocating saw. In addition, the osteotomy was performed on the zygomatic arch from the inside out with an angle of 20 degrees horizontally.
Results: From 1997 to 2010, we were satisfied with the results of 114 cases of malarplasty with the intraoral approach and L osteotomy as the observed objects. There are 103 cases for women and 11 for men. Ages ranged from 16 to 48 years. The mean operation time is approximately 1 hour. We just had a few complications: 3 nonunion at the osteotomy line and needed a second surgery to repair as well as 2 slight cheek drooping during the initial period and required face lifting.
Conclusions: The method of intraoral approach and L-shaped osteotomy for zygoma reduction can reduce prominent zygoma while maintaining the natural curves of the zygomatic body and arch. Because of the simple procedures, fewer complications, and excellent results, this method will be considered a relatively desirable way.
Level of Evidence: Therapeutic, III.]]>Thu, 01 May 2014 00:00:00 GMT-05:0000001665-201405000-00008http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/06000/Preliminary_Study_on_Composition_and.115.aspx
Abstract: To analyze the element composition and microstructure of calcification in craniopharyngiomas and to explore the differences among differing degrees of calcification, 50 consecutive patients with craniopharyngioma were selected. X-ray diffraction analysis and energy-dispersive X-ray spectroscopy analysis were performed on the calcified plaques isolated from the tumor specimens. All calcified plaques were constituted of hydroxyapatite crystals and some amorphous materials. The main elements for the analysis were calcium, phosphate, carbon, and oxygen. There were significant differences among groups of differing degrees of calcification in the percentage composition of calcium, phosphorus, and carbon (P Wed, 01 Jun 2016 00:00:00 GMT-05:0000001665-201606000-00115http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Nasoalveolar_Molding_Therapy_for_the_Treatment_of.14.aspx
Objective: The aim of this study is to assess the esthetic and morphologic outcomes before surgery using nasoalveolar molding (NAM) therapy in children with unilateral cleft lip and palate.
Design: A prospective analysis was performed.
Setting: The study was carried out in the Congenital Malformations Craniofacial and Cleft Lip and Palate Unit, Hospital Virgen de las Nieves, Andalusian Health Service, Granada (Spain).
Patients: Twenty consecutively enrolled infants ranging in age from 7 to 30 days with nonsyndromic unilateral cleft lip and palate treated from 2008 to 2012.
Interventions: All patients were treated with NAM appliances to align the alveolar segments and reduce severity of the nasal deformity.
Main Outcome Measure: The extraoral nasal measurements were performed on casts and nasal photographs. The measurements consisted of bialar width (BAW), columellar deviation (CD), cleft nostril height (CNH), cleft nostril width (CNW), non-CNH, non-CNW, and the deviation of the columella to the horizontal line represented by bilateral pupil line (BIA). The authors have made the measurements following Barilla method. Also 2 intraoral measurements were taken.
Results: Following NAM the extraoral records showed a statistically significant decrease in CD (P Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00014http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/09000/Clinical_Evaluation_of_an_Unsintered.5.aspx
Introduction: OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-L-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX.
Methods: The authors treated 35 patients (19 men, 16 women; age, 14–88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines.
Results: All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients—plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue.
Conclusion: OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures.]]>Thu, 01 Sep 2016 00:00:00 GMT-05:0000001665-201609000-00005http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Assessment_of_Deformational_Plagiocephaly_Severity.6.aspx
Abstract: Deformational plagiocephaly (DP) in infants has been associated with developmental delay that can last until adolescence. Despite this association and a 5-fold increase in incidence of DP over the past 2 decades, there are currently no guidelines regarding screening for developmental delay or identification of which infants with DP are at the greatest risk of delay. A prospective, nonrandomized study was performed. Infants diagnosed with DP who had no prior intervention were eligible for enrollment. Cranial deformity was measured by cross-cranial measurements using calipers, and developmental delay was measured using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Correlation between cranial deformity and developmental delay was analyzed using a linear regression. Twenty-seven infants, ages 4.0 to 11.0 months (mean = 6.61 months) diagnosed with DP were studied. Developmental delay was observed on the composite language (n = 3 of 27, 11%), and composite motor (n = 5 of 23, 22%) scales, but not the cognitive scale. Severity of cranial deformity did not correlate with scores on any Bayley-III scales (cognitive R2 = 0.058, P = 0.238; composite language R2 = 0.03, P = 0.399; composite motor R2 = 0.0195, P = 0.536). This study demonstrates that severity of cranial deformity cannot be used to predict presence or degree of developmental delay. Craniofacial surgeons should be aware of this risk and consider developmental screening based on clinical suspicion.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00006http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Assessment_of_the_Relationship_Between.9.aspx
Abstract: Temporomandibular joint disorders (TMJDs) are a complex group of disorders that comprise dysfunctions of the temporomandibular joint (TMJ). In this study, we analyzed the objective and subjective findings of the TMJD patients by using Helkimo anamnesis (Ai) and clinical dysfunction (Di) indices, and tried to document a relation between these findings and magnetic resonance imaging (MRI) results.
Ninety-eight patients who were admitted to our clinic were included in the study. The clinical evaluation was performed by using Ai, an 8-question-survey based on the objective symptoms of patients; Di, concluded as the score of 5 objective measurements of physical examination. The morphology of the TMJ was evaluated by MRI, and the findings were analyzed and statistically compared with respect to the Di.
The most commonly seen symptoms were noise during mandibular movement (58%), pain around the joint (42.5%), and pain with mandibular movements (40%). Seventeen patients (17.3%) were Di0, 47 (48%) were DiI, 24 (24.5%) were DiII, and 10 (10.2%) were DiIII. Thirty-seven patients (37.8%) had abnormal MRI findings, whereas 61 patients (62.2%) had normal MRI. The most commonly encountered pathology was anterior disc displacement with reduction, which was reported in 15 patients. Increased TMJ Di, which points a more progressed TMJD, was found to be significantly related with the pathological MRI findings (P Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00009http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Pediatric_Craniofacial_Fractures___Trajectories.64.aspx
No abstract available]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00064http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/One_Global_Community_Under_God_in_One_Arena___The.1.aspx
No abstract available]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00001http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Anesthesia_Management_in_Patients_With_Choanal.17.aspx
Background: In this study, the anaesthetic management of newborn and infant patients who underwent surgery for choanal atresia between 2009 and 2016 is discussed in the light of recently published literature.
Methods: The diagnoses, demographic data, anaesthetic risk and duration, additional anomalies, airway management, and complications that arose in 41 patients with choanal atresia who were operated on between 2009 and 2016 were evaluated retrospectively by examining their medical and anaesthesia records.
Results: The patients were divided into 2 groups: Group I—bilateral choanal atresia and Group II—unilateral choanal atresia. Of the 41 patients included in the study, 24 (58.53%) were in the bilateral group, and 17 (41.46%) were in the unilateral group. Fifteen (34.1%) of the patients were male, and 26 (59.1%) of the patients were female. The mean age of the 24 patients in Group I was 25.86 days (3–72), and the mean age of the 17 patients in Group II was 171.08 days (81–365). Additional congenital anomalies were present in 13 of the patients in the bilateral choanal atresia group and 3 of the patients in the unilateral choanal atresia group.
Seven patients from Groups I and 2 patients from Group II were determined to have difficult airways. The laryngoscopic images from these patients were classified as grades 3 and 4 according to the Cormack–Lehane classification system. When the durations of anesthesia in the groups were compared, the duration of anesthesia in Group I was found to be significantly longer (Table 3). Anesthesia-related complications were observed in 9 patients (37.5%) from the bilateral choanal atresia group and in 4 patients (2.3%) from the unilateral atresia group. Steroids were used as prophylactics in these patients.
Conclusions: Congenital anomalies and their associated risks, as well as intubation and ventilation problems and the complications that might arise, must be considered in addition to anesthetic management when repairing choanal atresia in newborn and infant patients.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00017http://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/03000/Comparison_of_the_Osteogenic_Potential_of.90.aspx
Abstract: The purpose of this study was to compare the osteogenic potential of a synthetic and a demineralized bone matrix (DBM) putty using a cranial defect model in New Zealand white rabbits. Paired, bilateral critical-size defects (10 mm) were prepared in the frontal bones of 12 rabbits and filled with either OsteoSelect DBM Putty or NovaBone calcium-phosphosilicate putty. At days 43 and 91, 6 rabbits were killed and examined via semiquantitative histology and quantitative histomorphometry. Defects filled with the DBM putty were histologically associated with less inflammation and fibrous tissue in the defect and more new bone than the synthetic counterpart at both time points. Histomorphometric analysis revealed that the defects filled with DBM putty were associated with significantly more bone formation at day 43 (70.7% vs 40.7%, P = 0.043) and at day 91 (70.4% vs 39.9%, P = 0.0044). The amount of residual implant was similar for both test groups at each time point.]]>Sat, 01 Mar 2014 00:00:00 GMT-06:0000001665-201403000-00090http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/10000/Patients_With_Lower_Eyelid_Orbital_Fat_Hyperplasia.35.aspx
Purpose: Lower eyelid orbital fat hyperplasia has not been described in young age patients.
Methods: A fourteen-year-old girl, a 29-year-old man, and 42-year-old man had visited our hospital complaining of a lower eyelid bulge. In orbital computed tomography examination, there was excess fat tissue compared with the opposite side, but no mass lesion matched with the area of lower eyelid bulge in our patients. The authors planned surgery for the removal of excess fat through the conjunctival incision. Intraoperatively, there was no real fat herniation through the septum. Septum continuity was maintained and thinning or distention of the orbital septum was not observed in our patients. The authors opened the orbital septum and removed the excess fat to make symmetry bilaterally. In the pathologic examination, removed fat tissue is not different with normal fat tissue.
Conclusions: The authors reported these findings at the first time. So they proposed the patient's condition as “lower eyelid orbital fat hyperplasia.”]]>Thu, 01 Oct 2015 00:00:00 GMT-05:0000001665-201510000-00035http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/01000/Management_of_Rhinomyasis_in_an_Elderly_and_Senile.66.aspx
No abstract available]]>Fri, 01 Jan 2016 00:00:00 GMT-06:0000001665-201601000-00066http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/09000/Initial_Exploration_on_Temporal_Branch_of_Facial.49.aspx
Background: Large temporal plexiform neurofibroma (PNF) is an irritating problem that causes facial disfigurement. Surgical resection of PNF is the only effective way to remove the tumor as well as to improve the patient's facial appearance. However, temporal branch of the facial nerve (TBFN) in the tumor is prone to be destroyed during PNF removal. Thus, TBFN palsy is the inevitable complication after surgery and might induce other malformation and dysfunction. Therefore, the aim of this study is to reconstruct a nearly normal face contour while preserving the facial nerve function.
Purpose: Selective PNF removal technique was designed to protect TBFN during PNF lesions resection in our patients.
Methods: From May 2011 to June 2015, the authors had 10 patients who suffered from PNF in the temporal region with facial disfigurement and underwent selective PNF removal to correct the facial disfigurement while preserving TBFN as well.
Result: All patients obtained the improvement of facial appearance after surgery. The temporal PNF was removed and the TBFN function successfully maintained. Plexiform neurofibroma recurrence has not been relapsed during 6 to 49 months’ follow-up.
Conclusions: In our initial exploration, TBFN function maintenance and facial appearance improvement can be achieved simultaneously by using PNF-selective removal surgery technique.]]>Thu, 01 Sep 2016 00:00:00 GMT-05:0000001665-201609000-00049http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/06000/The_Effect_of_Cigarette_Smoking_on_the_Healing_of.81.aspx
No abstract available]]>Wed, 01 Jun 2016 00:00:00 GMT-05:0000001665-201606000-00081http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Risk_Factors_Leading_to_Free_Flap_Failure__.11.aspx
Background: The objective of this study was to identify risk factors for free flap failure among various anatomically based free flap subgroups.
Methods: The 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing microvascular free tissue transfer based on current procedural terminology codes. Univariate analysis was performed to identify any association between flap failure and the following factors: age, gender, race, body mass index (BMI), diabetes, smoking, alcohol use, hypertension, intraoperative transfusion, functional health status, American Society of Anesthesiologists class, operative time, and flap location. Factors yielding a significance of P Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00011http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Rotation_Technique_of_Reduction_Malar_Plasty.54.aspx
Abstract: The 2 most common complications of reduction malarplasty are nonunion or malunion and cheek drooping. Because masseter muscle is attached from zygomatic process of the maxilla to inferior two thirds of the zygomatic arch, rigid fixation and intimate bone contact without creating a gap are crucial for reduction malarplasty.
Mesial-clockwise rotation of the zygomaticomaxillary complex can produce intimate bone contact and facilitates reduction malarplasty.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00054http://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/09000/Providing_More_Than_Health_Care___The_Dynamics_of.11.aspx
Abstract: Humanitarian cleft surgery has long been provided by teams from resource-rich countries traveling for short-term missions to resource-poor countries. After identifying an area of durable unmet need through surgical missions, Operation Smile constructed a permanent center for cleft care in Northeast India. The Operation Smile Guwahati Comprehensive Cleft Care Center (GCCCC) uses a high-volume subspecialized institution to provide safe, quality, comprehensive, and cost-effective cleft care to a highly vulnerable patient population in Assam, India. The purpose of this study was to profile the expenses of several cleft missions carried out in Assam and to compare these to the expenditures of the permanent comprehensive cleft care center. We reviewed financial data from 4 Operation Smile missions in Assam between December 2009 and February 2011 and from the GCCCC for the 2012–2013 fiscal year. Expenses from the 2 models were categorized and compared. In the studied period, 33% of the mission expenses were spent locally compared to 94% of those of the center. The largest expenses in the mission model were air travel (48.8%) and hotel expenses (21.6%) for the team, whereas salaries (46.3%) and infrastructure costs (19.8%) made up the largest fractions of expenses in the center model. The evolution from mission-based care to a specialty hospital model in Guwahati incorporated a transition from vertical inputs to investments in infrastructure and human capital to create a sustainable local care delivery system.]]>Mon, 01 Sep 2014 00:00:00 GMT-05:0000001665-201409000-00011http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/06000/Measuring_and_Comparing_the_Cost_Effectiveness_of.35.aspx
Abstract: Cleft lip and palate (CLP) care is the longest sustained global effort in humanitarian surgical care. However, the relative cost-effectiveness of surgical delivery approaches remains largely unknown. We assessed the cost-effectiveness of two strategies of CLP surgical care delivery in low resource settings: medical mission and comprehensive care center.
We evaluated the medical records and costs for 17 India-based medical missions and a Comprehensive Cleft Care Center in Guwahati, India, from Operation Smile, a humanitarian nongovernmental organization. Age, sex, diagnosis, and procedures were extracted and cost/Disability-Adjusted Life Year (DALY) averted was calculated using a provider's perspective. The disability weights for CLP from the Global Burden of Disease (GBD) 2010 update were used as the reference case. Sensitivity analysis was performed using various disability weights, age-weighting, discounting, and cost perspective.
The medical missions treated 3503 patients for first-time cleft procedures and averted 6.00 DALYs per intervention with a cost-effectiveness of $247.42/DALY. The care center cohort included 2778 patients with first-time operations for CLP and averted a mean of 5.96 DALYs per intervention with a cost-effectiveness of $189.81/DALY. The Incremental Cost-Effectiveness Ratio (ICER) of choosing medical mission over care center is $462.55.
The care center provides cleft care with a higher cost-effectiveness, although both models are highly cost-effective in India, in accordance with WHO guidelines. Compared to other global health interventions, cleft care is very cost-effective and investment in cleft surgery might be realistic and achievable in similar resource-constrained environments.]]>Mon, 01 Jun 2015 00:00:00 GMT-05:0000001665-201506000-00035http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/10000/Three_Dimensional_Anthropometric_Database_of.69.aspx
Abstract: The aim of this paper is to develop a database to determine a new biomorphometric standard of attractiveness. Sampling was carried out using noninvasive three-dimensional relief methods to measure the soft tissues of the face. These anthropometric measurements were analyzed to verify the existence of any canons with respect to shape, size, and measurement proportions which proved to be significant with regard to the aesthetics of the face. Finally, the anthropometric parameters obtained were compared with findings described in the international literature.
The study sample was made up competitors in the Miss Italy 2010 and 2009 beauty contest. The three-dimensional (3D) scanning of soft tissue surfaces allowed 3D digital models of the faces and the spatial 3D coordinates of 25 anthropometric landmarks to be obtained and used to calculate linear and angular measurements. A paired Student t test for the analysis of the means allowed 3 key questions in the study of biomorphometric parameters of the face to be addressed through comparison with the data available in the literature.
The question of statistical evidence for the samples analyzed being members of the populations samples reported in literature was also addressed.
The critical analysis of the data helped to identify the anthropometric measurements of the upper, middle, and lower thirds of the face, variations in which have a major influence on the attractiveness of the face. These changes involve facial width, height, and depth. Changes in measurements of length, angles, and proportions found in the sample considered were also analyzed.]]>Sat, 01 Oct 2016 00:00:00 GMT-05:0000001665-201610000-00069http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/09000/Delayed_Acute_Subdural_Hematoma_Associated_With.64.aspx
Background: Delayed acute subdural hematoma (DASH) is a subdural hematoma which is detected later. An initial computed tomography (CT) does not reveal any intracranial hemorrhage at all. Few patients of DASH after mild traumatic brain injury associated with percutaneous coronary intervention (PCI) have been published.
Patient Presentation: A 63-year-old woman presented with cardiac pulmonary arrest due to acute myocardial infarction and lethal arrhythmia. She had hit her head on the road. The initial CT did not reveal any hemorrhage in the intra-cranium. She fully recovered after PCI. However, 1 hour after PCI, she lost consciousness and immediate CT showed acute subdural hematoma and subarachnoid hemorrhage. The period from losing consciousness to brain herniation presenting as anisocoria was very short—only 30 minutes in our patient. Although emergent evacuation of hematoma and external decompression were performed, the patient died 1 day after the operation.
Conclusion: The authors encountered a patient of DASH after PCI that resulted in death. Clinicians should be aware that subdural hemorrhage can occur after PCI if no hemorrhage is noted in the initial head CT, and the operation should be performed as soon as possible when the consciousness level decreases.]]>Thu, 01 Sep 2016 00:00:00 GMT-05:0000001665-201609000-00064http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Virtual_Surgery_Planning_in_Orthomorphic.54.aspx
Abstract: Three-dimensional virtual surgery programs are widely available for orthognathic surgery. The advent of imaging software programs has proved to be useful for diagnosis, treatment planning, outcome measurement, and three-dimensional surgical simulation. Complex maxillofacial malformations continue to present challenges in analysis and correction beyond modern technology. Orthomorphic correction for mandibular dysmorphology refers to basal bone movement without any change in dental component. The purpose of this paper is to present a virtual surgery planning for surgeons to perform the orthomorphic surgery with precision and quantification. Moreover, it provides an essential educational tool for patients to foresee predicted surgical outcome.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00054http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/A_Simple_Closure_Technic_for_Tracheoesophageal.51.aspx
Abstract: Tracheosephageal puncture is the one of the most favorable methods, and widely used by physicians for voice reconstruction after total laryngectomy. Intractable leakages from the tracheosephageal punctures are the most common complication, and management of these fistulas is still troublesome for the patients and physicians. Local surgical sutures, rotational flaps, injections are reported previously, but in this report the authors aimed to mention on a very simple method with silicone septal button. Insertion of a temporary silicone septal button may be well tolerated by patients and can help to manage this complication easily on exact indications. The authors discussed indications and long-term results of this method with different patients.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00051http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Correction_of_a_Long_Face___Simultaneous_Reduction.7.aspx
Background: Although Le Fort I osteotomy superior impaction during bimaxillary surgery is beneficial for patients with a long face, achieving satisfactory results can be challenging due to the redundant upper lip. However, upper-lip reduction has rarely been performed during or following bimaxillary surgery because of the difficulty in estimating the required amount of cutaneous resection needed and the apparent horizontal scars left behind. Therefore, no simultaneous cutaneous upper-lip reduction with orthognathic surgery has been reported. The authors present successful clinical outcomes using a modified endonasal upper-lip reduction technique performed with orthognathic surgery.
Methods: A total of 33 patients underwent simultaneous cutaneous upper-lip reduction with orthognathic surgery. Of those, 15 patients were statistically analyzed. The amount of skin excised was individualized depending on the amount of Le Fort I osteotomy superior impaction and the aesthetic goal. Postoperative changes in upper-lip length were assessed with lateral cephalography.
Results: Most patients had satisfactory results without serious complications. Overall lip contours, especially lip height, were greatly improved. The scar was hidden intranasally, aside from inconspicuous scarring in the subalar area. Regarding Le Fort I osteotomy, the amount of superior impaction averaged 3.26 mm (range, 0–6.0). The amount of upper-lip reduction averaged 3.42 mm (range, 3.0–6.0). Upper-lip length decreased from 25.27 ± 0.94 mm preoperatively to 21.22 ± 0.94 mm postoperatively (P Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00007http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Computer_Image_Guided_Template_for_Horizontal.20.aspx
Background: Horizontal advancement genioplasty can be extremely rewarding for microgenia. However, it is challenging for even very experienced surgeon to determine the three-dimensional position of the distant bone fragment during the operation. This study aimed to apply and evaluate computer-aided design (CAD) and computer-aided manufacturing techniques for horizontal advancement genioplasty to improve surgical accuracy.
Methods: Seven patients with microgenia were prospectively enrolled in the study. Preoperative and postoperative computed tomography (CT), photographs, and lateral cephalograms were performed. Computer-aided design was done based on preoperative CT data, and then surgical templates (cutting guide templates and fixation templates) were designed accordingly to guide horizontal advancement genioplasty. All surgeries were performed by junior surgeons. The accuracy of the authors’ method was evaluated by the relative error (the mean value of discrepancy between postoperative CT and preoperative design at 6 points selected randomly/preoperative design movement × 100%), Pg position error (postoperative Pg Advancement – preoperative CAD Pg Advancement)/preoperative CAD Pg Advancement × 100%), and Me position error (postoperative Me downward movement − preoperative CAD Me downward movement)/preoperative CAD Me downward movement × 100%). They are all calculated by Geomagic automatically.
Results: All 7 patients were satisfied with their aesthetic outcomes. The average absolute relative error is 1.8%. The average absolute Pg position error is 1.9% and the average absolute Me position error value is 1.3%.
Conclusions: The authors’ study showed that applying computer-assisted techniques for horizontal advancement genioplasty provided accurate surgical result. With this technique, best result for horizontal advancement genioplasty could be achieved by even inexperienced surgeons.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00020http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/The_Comparison_of_the_Efficacy_of_Blue.65.aspx
Abstract: The aim of this study is to histologically compare effects of blue light-emitting diode (LED) light (400–490 nm) and Ga–Al–As low-level diode laser light (980 nm) on bone regeneration of calvarial critical-sized defects in rats. Thirty Wistar Albino rats were included in the study. The experimental groups were as follows: blue LED light (400–490 nm) group (LED); 980-nm low-level laser light group (LL); and no-treatment, control group (CL). A critical-sized defect of 8 mm was formed on calvaria of rats. Each animal was sacrificed 21 days after defect formation. Calvarias of all rats were dissected and fixated for histological examination. Histomorphometric measurements of total horizontal length of the newly produced bone tissue, total vertical length of the newly produced bone tissue, and diameter of the newly produced longest bone trabecula were performed with a computer program in micrometers. There was a statistically significant increase in the total horizontal length and total vertical length in LL and LED groups compared to that in the CL group (P 0.05). A statistically significant difference was observed in the longest bone trabecula and LL groups compared to that in CL (P 0.05). In conclusion, blue LED light significantly enhances bone regeneration in critical-sized defects when compared with CL group, but does not have a statistically significant effect on bone regeneration when compared with 980-nm low-level laser light.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00065http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Jaw_in_a_Day___State_of_the_Art_in_Maxillary.39.aspx
Background: Reconstruction of maxillary defects following tumor extirpation is challenging because of combined aesthetic and functional roles of the maxilla. One-stage reconstruction combining osseous free flaps with immediate osseointegrated implants are becoming the standard for mandibular defects, and have similar potential for maxillary reconstruction.
Methods: A woman with maxillary Ewing sarcoma successfully treated at age 9 with neoadjuvant chemotherapy, right hemimaxillectomy, and obturator prosthetic reconstruction presented for definitive reconstruction, complaining of poor obturator fit, and hypernasality. Her reconstruction was computer-simulated by a multidisciplinary team, consisting of left hemi-Lefort I advancement and right maxillary reconstruction with a free fibula flap with immediate osseointegrated implants and dental prosthesis.
Results: Full dental restoration, midface projection, and oral fistula corrections were achieved in 1 operative stage using this approach.
Conclusions: This patient demonstrates a successful approach for maxillary reconstruction using computer-planned orthognathic surgery with free fibula reconstruction and immediate osseointegrated implants with dental prosthesis.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00039http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/06000/Pseudoaneurysm_in_the_Internal_Maxillary_Artery.46.aspx
Abstract: Pseudoaneurysm is defined as blood leaking out of a vessel that does not have true 3 arterial walls like a true aneurysm, and is susceptible to rupture. Only 4 patients of pseudoaneurysm after endoscopic sinus surgery have been reported so far in English literature. Recently, the authors encountered a pseudoaneurysm in the internal maxillary artery after endoscopic sinus surgery, which was immediately and successfully managed with endovascular embolization. There was no bleeding or complications 6 months after the embolization.]]>Wed, 01 Jun 2016 00:00:00 GMT-05:0000001665-201606000-00046http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/01000/Study_of_Condylar_Asymmetry_in_Angle_Class_III.63.aspx
No abstract available]]>Fri, 01 Jan 2016 00:00:00 GMT-06:0000001665-201601000-00063http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/06000/A_Comparison_of_Free_Tissue_Transfers_to_the_Head.80.aspx
No abstract available]]>Wed, 01 Jun 2016 00:00:00 GMT-05:0000001665-201606000-00080http://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/09000/Development_and_Validation_of_the_Quality_of_Life.39.aspx
Abstract: Only a few reports in the literature have described the use of specific instruments for assessing the quality of life in adolescents and young adults with cleft lip and palate (CLP). This condition markedly affects their lifestyle, even after surgical treatment. In the present study, we aimed to develop a quality-of-life assessment tool specifically designed for such patients with CLP. Our multidisciplinary team created a questionnaire focused on the physical, psychological, and social satisfaction of adolescents and young adults with CLP, which was adapted from 3 dimensions of the 36-item Short-Form Health Survey. The questionnaire was administered to a randomized sample of 40 adolescents and young adults (aged 16–24 years) with CLP who had completed treatment protocols and 40 (aged 16–24 years) who were not affected by CLP.
The statistical results stated that the questionnaire had good reliability and validity; the Cronbach α coefficient was found to be 0.944. Moreover, factorial analysis confirmed the presence of 3 subscales that were the fundamental components of this questionnaire, which is consistent with the areas theoretically proposed and from which the items were designed and selected.
Thus, we validated our novel questionnaire that was administered in the present study and proved its consistency. However, further investigations on a larger population would be useful to confirm these findings.]]>Mon, 01 Sep 2014 00:00:00 GMT-05:0000001665-201409000-00039http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Management_of_Zygomatic_Fractures_in_Young.32.aspx
Introduction: The zygomaticomaxillary complex is very vulnerable to injury because of its intrinsically prominent convexity. There are 2 different surgical approaches for the therapy of these fractures: closed reduction and open reduction. In the open reduction 2 or 3 fixation points with related incisions are usually necessary in dislocated fractures: osteosynthesis must be performed starting from zygomaticofrontal suture when dislocated at this site, followed by zygomatic body fixation on the anterior sinus wall, anterior orbital floor margin fixation, and finally orbital floor reconstruction in case of eye globe dislocation with diplopia.
Aim: This study evaluated the combination of the transconjunctival (TC) approach without canthotomy in association with the transoral maxillary approach and lateral rim skin incision (SI) without canthotomy for frontozygomatic dislocated fractures to achieve proper reduction and stabilization without any aesthetic decay in young patients. A less invasive and more aesthetic technique is shown for treating dislocated zygomaticomaxillary complex fractures with 2 or 3 fixation points and platelet-rich fibrin (PRF) use to promote tissue healing.
Materials and methods: Ten patients (mean age: 32) were referred for dislocated zygomaticomaxillary complex fracture. Five patients were treated by TC approach without canthotomy in association with the transoral maxillary approach and, when needed, eyebrow SI without canthotomy for frontozygomatic dislocated fractures (group 1). Five more patients were treated by traditional subciliar incision at lower eyelid and vertical lateral incision at lateral margin of the orbit (group 2). Autologous PRF for orbital floor reconstruction was used. The follow-up period was 6 months long. Follow-up radiographs (TC) and photos were routinely used to evaluate the adequacy of reduction and lower eyelid right position or retraction.
Results: All cases were successful; there were no problems at surgery and postoperative time. During the 6-month follow-up, all 5 patients of group 1 showed satisfactory facial symmetry, no noticeable scarring, no ectropion or lower eyelid significant droop, and no functional impairment. Mean difference for lower eyelid droop between the 2 groups of patients was 1.4 mm at T1 and 1.2 mm at T2.
Discussion: Aesthetic result is a priority in the treatment planning of orbitozygomatic fractures because of the fundamental role of the eye and lid area in the aesthetic of the face. In our experience best aesthetic results were achieved through a latero cantal horizontal SI combined to a vertical periosteal incision at the frontozygomatic rim without canthotomy, thus performing a different double-layer incision. In the patients with large orbital floor dislocation, reconstructive titanium mesh was covered by autologous PRF membranes, which can improve the vascularization of the surgical site, by promoting neoangiogenesis.
Conclusions: In young patients these techniques are indicated because of the need of better aesthetic results that can be achieved by preventing postoperative functional impairment with lower eyelid droop and unnatural aesthetic asymmetry of the 2 lower lids. This more conservative technique resulted in better aesthetic results, avoiding most common complications.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00032http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Optimization_of_Cranio_Orbital_Remodeling__.66.aspx
No abstract available]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00066http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/09000/Endonasal_Endoscopic_Transsphenoidal_Approach_to.6.aspx
Objective: Endoscopic endonasal (transnasal) transsphenoidal approach (EETA) for management of sellar lesions has gained popularity as a reliable and atraumatic method. Most reported studies of EETA have focused on surgical outcome in adult patients; and there are few reports to describe outcome in pediatric patients. The authors report our early experience of 11 patients aged 14 to 18 years managed with EETA to evaluate the safety and effectiveness of EETA in the pediatric.
Methods: Retrospective review of hospital records of 11 pediatric patients who underwent endonasal endoscopic transsphenoidal approach for resection of sellar region lesion over 2 years. Age, sex, symptoms, tumor size, extent of tumor resection, clinical outcome, and surgical complications were reviewed.
Results: Total resection was achieved in 9 (81.8%) patients, subtotal resection in 2 (18.2%), and no patient had partial or insufficient resection. All (100%) patients achieved visual remission, 7 (87.5%) of 8 patients with hyperhormone preoperative had endocrinological remission. Two (18.2%) patients incurred temporary diabetes insipidus (DI) postoperatively. One (9.1%) patient incurred postoperative cerebrospinal fluid (CSF) leakage which resolved following lumbar drainage. Three (27.3%) patients developed hypopituitarism needed hormone replacement therapy. There were no cases of meningitis, intracranial hematoma, or death.
Conclusions: Endoscopic endonasal (transnasal) transsphenoidal approach (EETA) provides a safe and effective surgical option with low morbidity and mortality in pediatric patients.]]>Tue, 01 Sep 2015 00:00:00 GMT-05:0000001665-201509000-00006http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/An_Ideal_Flap_Alternative_for_Closure_of.10.aspx
Background: Dorsal intercostal artery perforator (DICAP) flap is an ideal flap to be used for posterior trunk defects since it leads to lower donor-site morbidity and shorter operative times, offers easy surgical planning, and uses a reliable and easily identifiable artery.
Materials and Methods: The study retrospectively reviewed 52 patients with meningomyelocele defects that were closed with DICAP flap between January 2007 and May 2015.
Surgical Technique: Each of the 4th to 12th posterior intercostal arteries can be used as dorsal perforators. The dominant direct cutaneous perforators derive from the 4th, 5th, 6th, 10th, and 11th posterior intercostal arteries. These perforators are located 5 cm medial to the spinous processes of the thoracic vertebrae and can be easily identified.
Conclusion: Dorsal intercostal artery perforator flap is a reliable flap alternative for the defects seen in neonates, including myelomeningocele, oncologic resections, burn defects, and radiation burns since it is a thin flap and offers easy surgical planning and shorter operative times.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00010http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Analysis_of_Extended_Transconjunctival_Approach.29.aspx
Abstract: Although the subcilliary or conventional transconjunctival approach has been widely used, it often fails to get acceptable visual fields or scars. This study directly compared the extended transconjunctival approach accompanied by lateral paracanthal incision with other traditional approaches in terms of surgical fields, the outcomes and complications. This retrospective chart review included 113 patients (82 males and 31 females; mean age: 38.7 years; range: 11–87 years), who underwent orbital reduction from November 2009 to September 2013. In extended transconjunctival approach, the external skin of the inferolateral canthal tendon was demarcated in a natural skin crease approximately 5 mm from the lateral canthus. The surgical approach was based on anteroseptal transconjunctival dissection. Paracanthal incision about 5 mm in length was performed. Esthetic and functional complications were evaluated, including the presence of a visible scar, lid retraction, or hypertrophic scar; epiphora, diplopia, global hematoma, persistent enophthamos, or exophthamos; and presence of entropion/ectropion. The extended transconjunctival approach resulted in a significant increase in the area of the surgical field statistically significant (P = 0.002). Complication rates are similar with other approach techniques. Postoperative scarring was confirmed by pictures taken in the outpatient clinic. The physicians’ average Vancouver scar scale (VSS) of first physician was 1.26 and second physician was 1.2. Compared with the conventional transconjunctival approach, the extended transconjunctival approach with paracanthal incision had similar complication and scarring rates, as well as a lower scarring rate than the subciliary approach while providing much wider surgical fields.]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00029http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Review_of__Uncovering_the_Hidden_Curriculum_of.69.aspx
No abstract available]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00069http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/07000/Ocular_Motility_After_Repair_of_Combined_Medial.47.aspx
Purpose: To describe ocular motility and effectiveness of an extended conjunctival incision with reattachment of the inferior oblique muscle to repair combined orbital medial and inferior wall fractures.
Methods: The authors retrospectively studied 20 eyes from 20 patients who underwent combined orbital medial and inferior wall fractures surgery with reattachment of the inferior oblique muscle from January 2007 to December 2011. Single large L-shaped implant was inserted into the fracture site. All patients were evaluated preoperatively and postoperatively at 1, 3, and 6 months, by computed tomography, Hertel exophthalmometry, the Hess test of ocular motility, and the Goldmann diplopia test.
Results: Sixteen patients (80%) had no significant enophthalmos or diplopia after surgery. Inferior oblique motility was not changed in 12 patients (60%) after reattachment of the inferior oblique muscle. After 1 month, inferior oblique underaction was presented in 8 patients (40%) and in 4 patients (20%) after 6 months. Finally, only 2 patients (10%) had the inferior oblique underaction remained, it was not improved.
Conclusions: The extended conjunctival incision with reattachment of the inferior oblique muscle for combined orbital wall fracture repair offers a wide surgical field and space for a single large implant insertion and corrects the enopthalmos. The reattachment of the inferior oblique muscle does not contribute to the development of inferior oblique underactions or diplopia that was resolved spontaneously within 6 months after surgery.]]>Fri, 01 Jul 2016 00:00:00 GMT-05:0000001665-201607000-00047http://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/11000/Ephemeral_or_Timeless____The_Bront__Sisters.2.aspx
No abstract available]]>Tue, 01 Nov 2016 00:00:00 GMT-05:0000001665-201611000-00002